medication deprescribing
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Introduction
The process of weaning patients from inappropriate medications or unnecessary medications.
Notes
- pharmacist-led educational intervention successful in deprescribing inappropriate medications; however. only 1/4 of eligible patients agreed to participate[4]
- deprescribing may reduce risk for dementia[5]
- incident dementia diagnosis may be an opportunity to reduce polypharmacy by deprescribing medications inappropriate for the elderly with risk of further impairing cognition[35] (see Beer's criteria)
- pharmacist-led deprescribing led to more medications discontinued & more medications added, resulting in a non-signifivant reduction in medication complexity but not overall medication count[38]
- opioids may present a deprescribing challenge (see opioid deprescribing)
- deprescribing acetylcholinesterase inhibitors in nursing home residents with advanced dementia not associated with negative outcomes[8]
- deprescribing may reduce risk for falls, disability & death[6]
- cognitive-behavioral therapy during antidepressant taper is as effective as continuing antidepressants[25]
- most elderly are amenable to deprescribing[6][24][26]
- deprescribing with little effect on time to first emergency department visit, hospital readmission or death in hospitalized elderly[39]
- deprescribing in hospitalized elderly discharged to postacute care facility
- vitamins, supplements, laxatives, antihypertensives, anticoagulants, hypoglycemics & proton-pump inhibitors top cancidates in Shed-MEDS trial[34]
- medication review to target polypharmacy through deprescribing is recommended as part of a comprehensive management plan for frail elderly[41][42][43]
- the U.S. Deprescribing Research Network website[9] has guidelines, algorithms, & videos for deprescribing of
- multiple options for deprescribing from Medscape
- deprescribing antidiabetic drugs in the elderly[17]
- deprescribing bisphosphonates[19]
- deprescribing SSRI in elderly[20]
- deprescribing statins in elderly[21] (also see statin deprescribing)
- deprescribing Alzheimer agents[22]
- deprescribing proton pump inhibitors[23]
- deprescribing benzodiazepines
- Deprescribing.org has developed deprescribing guidelines & algorithms[31]
- deprescribing proton pump inhibitors[31]
- deprescribing antidiabetic drugs[31]
- deprescribing antipsychotics[31]
- deprescribing sedative/hypnotics including benzodiazepines[31]
- deprescribing Alzheimer agents (cholinesterase inhibitors & memantine)[31]
- deprescribing proton-pump inhibitors in ambulatory patients[32]
- deprescribing psychotropic drugs in nursing home residents with dementia[27]
- recognition that psychosis, agitation & difficult behavior in the elderly is best managed by non-pharmaceutical interventions
- clear extrinsic incentive necessary
- collaboration, communication, routines, & systematic procedures needed
- lack of resources & qualifications, concern about symptom relapse, & staff tolerance of drug adverse events need to be overcome[27]
- deprescribing antihypertensives in nursing home residents may be associated with 12-16% lower likelihood of 12 week progression of cognitive impairment[40]
- attitudes toward deprescribing among older adults with dementia[29]
- patient & provider perspectives on deprescribing proton pump inhibitors[30]
- an electronic decision support tool (MedSafer Tool) improved deprescribing in hospitalized elderly but did not change frequency of adverse medication effects[28]
- review of randomized controlled trials[15]
More general terms
More specific terms
- antidepressant deprescribing
- antimuscarinic deprescribing; anticholinergic deprescribing
- antipsychotic deprescribing
- deprescribing proton-pump inhibitor (PPI)
- discontinuation of chronic benzodiazepine use; benzodiazepine deprescribing
- opioid deprescribing
- statin deprescribing
Additional terms
References
- ↑ Endsley S Deprescribing Unnecessary Medications: A Four-Part Process. Fam Pract Manag. 2018;25(3):28-32 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29989773
Medscape. https://www.medscape.com/viewarticle/896726 - ↑ Farrell B, Pottie K, Thompson W et al Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017 May;63(5):354-364. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28500192 Free PMC Article
- ↑ Paauw DA 11 Drugs You Should Seriously Consider Deprescribing: 2018 Update Medscape Oncology. November 5, 2018. https://www.medscape.com/slideshow/deprescribing-6009041
- ↑ 4.0 4.1 Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: The D-PRESCRIBE randomized clinical trial. JAMA 2018 Nov 13; 320:1889. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30422193 https://jamanetwork.com/journals/jama/article-abstract/2714531
- ↑ 5.0 5.1 George J Deprescribing to Reduce Dementia - Causal link still elusive, but anticholinergic drugs may be a modifiable dementia risk factor. MedPage Today. June 24, 2019 https://www.medpagetoday.com/neurology/dementia/80665
Coupland CAC, Hill T, Dening T et al Anticholinergic Drug Exposure and the Risk of Dementia. A Nested Case-Control Study. JAMA Intern Med. Published online June 24, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31233095 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353
Khan NF, Bateman BT, LandonKhan JE et al Association of Opioid Overdose With Opioid Prescriptions to Family Members. JAMA Intern Med. Published online June 24, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31233088 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736355 - ↑ 6.0 6.1 6.2 Reeve E, Low LF, Hilmer SN. Attitudes of older adults and caregivers in Australia toward deprescribing. J Am Geriatr Soc 2019 Jun; 67:1204. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30756387 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15804
- ↑ Warner-Maron I Deprescribing and the Impact on Recruitment and Retention. Annals of Long-Term Care. Feb 27, 2020 https://www.managedhealthcareconnect.com/content/deprescribing-and-impact-recruitment-and-retention
Goyal P, Anderson TS, Bernacki GM, et al. Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults. J Am Geriatr Soc. 2020;68(1):78-86 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31509233 - ↑ 8.0 8.1 Niznik JD, Zhao X, He M et al. Risk for health events after deprescribing acetylcholinesterase inhibitors in nursing home residents with severe dementia. J Am Geriatr Soc 2020 Apr; 68:699-707 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31769507 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16241
- ↑ 9.0 9.1 U.S. Deprescribing Research Network Resources for Clinicians https://deprescribingresearch.org/resources-2/resources-for-clinicians/
- ↑ 10.0 10.1 Farrell B et al Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline Canadian Family Physician May 2017, 63 (5) 354-364; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28500192 PMCID: PMC5429051 Free PMC article https://www.cfp.ca/content/63/5/354
- ↑ 11.0 11.1 Bjerre LM et al Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia. Evidence-based clinical practice guideline. Canadian Family Physician Jan 2018, 64 (1) 17-27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29358245 PMCID: PMC5962971 Free PMC article https://www.cfp.ca/content/64/1/17
- ↑ 12.0 12.1 University of Sydney Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/deprescribing-guideline.pdf
University of Sydney Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine: Recommendations. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/deprescribing-recommendations.pdf - ↑ 13.0 13.1 Farrell B et al Deprescribing antihyperglycemic agents in older persons. Evidence-based clinical practice guideline. Canadian Family Physician Nov 2017, 63 (11) 832-843 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29138153 PMCID: PMC5685444 Free PMC article https://www.cfp.ca/content/63/11/832
- ↑ 14.0 14.1 Pottie K, Thompson W, Davies S et al Deprescribing benzodiazepine receptor agonists. Canadian Family Physician May 2018, 64 (5) 339-351 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29760253 PMCID: PMC5951648 Free PMC article <Internet> http://www.cfp.ca/content/64/5/339
- ↑ 15.0 15.1 Dills H, Shah K, Messinger-Rapport B et al Deprescribing Medications for Chronic Diseases Management in Primary Care Settings: A Systematic Review of Randomized Controlled Trials. J Am Med Dir Assoc. 2018 Nov;19(11):923-935.e2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30108032 https://higherlogicdownload.s3-external-1.amazonaws.com/AMERICANGERIATRICS/844922fc-f4fd-4281-8b92-c444407ae9f5_file.pdf
- ↑ Holmes HM, Haley DC, Alexander GC, Sachs GA Reconsidering Medication Appropriateness for Patients Late in Life. Arch Intern Med. 2006 Mar 27;166(6):605-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16567597
- ↑ 17.0 17.1 Vega CP Stop or Switch the Antidiabetic Drug? Medscape - Aug 14, 2019. https://www.medscape.com/viewarticle/916642
Vega CP Deprescribing Antidiabetic Drugs: The Crowdsourced Opinion. Medscape - Oct 16, 2019. https://www.medscape.com/viewarticle/919644 - ↑ 18.0 18.1 Vega CP Is It the Right Time to Deprescribe This Frail Patient's Metformin? Medscape - May 20, 2021. https://www.medscape.com/viewarticle/951314
- ↑ 19.0 19.1 Vega CP Deprescribing Bisphosphonates: The Crowdsourced Opinion. Medscape - Jul 24, 2019. https://www.medscape.com/viewarticle/915729
Vega CP When to Stop the Bisphosphonate. Medscape - May 31, 2019. https://www.medscape.com/viewarticle/913559 - ↑ 20.0 20.1 Vega CP Cite this: Deprescribing SSRIs: The Crowdsourced Response. Medscape - May 03, 2019. https://www.medscape.com/viewarticle/912385
Vega CP Cases in Deprescribing: When to Stop the SSRI. Medscape - Mar 26, 2019 https://www.medscape.com/viewarticle/910669 - ↑ 21.0 21.1 Vega CP Cases in Deprescribing: When to Get Rid of the Statin. Medscape - Jan 31, 2019 https://www.medscape.com/viewarticle/908235
Vega CP Statin Deprescribing Follow-up: How You Voted. Medscape - Feb 26, 2019. https://www.medscape.com/viewarticle/909424 - ↑ 22.0 22.1 Vega CP Are Dementia Drugs Serving This Patient Well? Medscape - Jan 08, 2020. https://www.medscape.com/viewarticle/923343
Vega CP Deprescribing Alzheimer's Drugs: The Crowdsourced Opinion Medscape - Feb 24, 2020. https://www.medscape.com/viewarticle/925445 - ↑ 23.0 23.1 Vega CP Continue, Stop, or Taper the PPI? Medscape - Oct 25, 2019. https://www.medscape.com/viewarticle/920314_2
Vega CP Another Reason to Stop the PPI: Clinician Debate Medscape - Oct 13, 2020. https://www.medscape.com/viewarticle/938726 - ↑ 24.0 24.1 Lundby C, Glans P, Simonsen T et al Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents. J Am Geriatr Soc 2021. 69(6):1508-1518 June. first Published Feb 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33598916 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17054
- ↑ 25.0 25.1 Breedvelt JJF et al. Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression. JAMA Psychiatry 2021 May 19; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34009273 PMCID: PMC8135055 (available on 2022-05-19) https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780290
- ↑ 26.0 26.1 26.2 Navid P, Nguyen L, Jaber D et al Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction. J Am Geriatr Soc 2021. 69(7):1948-1955 July PMID: https://www.ncbi.nlm.nih.gov/pubmed/33978239 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17204
- ↑ 27.0 27.1 27.2 Moth AE, Holmkjaer P, Holm A et al What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators. Drugs Aging 2021. July 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34231182 https://link.springer.com/article/10.1007/s40266-021-00875-1
Harrison SL, Cations M, Jessop T, Hilmer SN, Sawan M, Brodaty H. Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia. Drugs Aging. 2019 Feb;36(2):125-136. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30535930 Review. - ↑ 28.0 28.1 McDonald EG, Wu PE, Rashidi B et al. The MedSafer study - Electronic decision support for deprescribing in hospitalized older adults: A cluster randomized clinical trial. JAMA Intern Med 2022 Jan 18; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/35040926 PMCID: PMC8767487 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788297
- ↑ 29.0 29.1 Matthews S Deprescribing Among Older Adults With Dementia. Annals of Long-Term Care. 2022. March 10. https://www.hmpgloballearningnetwork.com/site/altc/news/deprescribing-among-older-adults-dementia
Growdon ME, Espejo E, Jing B et al. Attitudes toward deprescribing among older adults with dementia in the United States. J Am Geriatr Soc. 2022. March 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35266141 - ↑ 30.0 30.1 Ikeji C, Williams A, Hennawi G, Brandt NJ. Patient and Provider Perspectives on Deprescribing Proton Pump Inhibitors. J Gerontol Nurs. 2019 Oct 1;45(10):9-17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31560071
- ↑ 31.0 31.1 31.2 31.3 31.4 31.5 31.6 Deprescribing.org Deprescribing Guidelines and Algorithms. https://deprescribing.org/resources/deprescribing-guidelines-algorithms/
- ↑ 32.0 32.1 Targownik LE et al. AGA clinical practice update on de-prescribing of proton pump inhibitors: Expert review. Gastroenterology 2022 Apr; 162:1334. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35183361 https://www.gastrojournal.org/article/S0016-5085(21)04083-X/fulltext
- ↑ Reeve J, Maden M, Hill R et al. Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technol Assess. 2022;26(32):1-148 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35894932 PMCID: PMC9376985 Free PMC article https://psnet.ahrq.gov/issue/deprescribing-medicines-older-people-living-multimorbidity-and-polypharmacy-tailor-evidence
- ↑ 34.0 34.1 Vasilevskis EE et al. Deprescribing medications among older adults from end of hospitalization through postacute care: A Shed-MEDS randomized clinical trial. JAMA Intern Med 2023 Feb 6; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36745422 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2800886
- ↑ 35.0 35.1 Anderson TS, Ayanian JZ, Curto VE et al Changes in the Use of Long-Term Medications Following Incident Dementia Diagnosis. JAMA Intern Med. Published online August 21, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37603340 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808238
Growdon ME, Smith AK The Maelstrom of Medications - Optimization of Prescribing During the Course of Dementia. JAMA Intern Med. Published online August 21, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37603360 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808241 - ↑ Rubin R Deciding When It's Better to Deprescribe Medicines Than to Continue Them. JAMA. Published online November 29, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38019481 https://jamanetwork.com/journals/jama/fullarticle/2812506
- ↑ Silva Almodovar A, Keller MS, Lee J et al Deprescribing medications among patients with multiple prescribers: A socioecological model. J Am Geriatr Soc. 2024 Mar;72(3):660-669. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37943070 Free PMC article. https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18667
- ↑ 38.0 38.1 Green AR, Quiles R, Daddato AE et al Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study. J Am Ger Soc 2024 72(7):1973-1984 Epub: March 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38488757 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18867
Pickering AN, Anderson TS Deprescribing for people living with dementia: ALIGNing interventions and outcomes. J Am Ger Soc 2024 72(7):1949-1951 Epub: May 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38751095 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18946 - ↑ 39.0 39.1 Lee JW, Hollingsworth EK, Shah AS, et al Emergency department visits and hospital readmissions after a deprescribing intervention among hospitalized older adults. J Am Ger Soc 2024 72(7):2038-2047 Epub: May 9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38725307 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18945
- ↑ 40.0 40.1 Jing B, Liu X, Graham LA et al Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents. JAMA Intern Med. 2024 Sep 23:e244851. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39312220
- ↑ 41.0 41.1 Curtin D, Jennings E, Daunt R Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria. J Am Geriatr Soc. 2020 Apr;68(4):762-769. doi:http://dx.doi.org/ 10.1111/jgs.16278. Epub 2019 Dec 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31868920 Clinical Trial.
- ↑ 42.0 42.1 Cole JA, Goncalves-Bradley DC, Alqahtani M et al Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2023 Oct 11;10(10):CD008165. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37818791 Free PMC article. Review.
- ↑ 43.0 43.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 44.0 44.1 Phelan EA, Williamson BD, Balderson BH, et al. Reducing Central Nervous System-Active Medications to Prevent Falls and Injuries Among Older Adults: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2024 Jul 1;7(7):e2424234. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39052289 PMCID: PMC11273227 Free PMC article